The upper extremity in COP requires classification schemes of its own. One review supports the use of the Manual Ability Classification System (MACS) and House methods.  delay In speech development (common) Typically, children talk in short sentences by 2 years. A delay in speech development may reflect motor delay or an intellectual disability. Speech delay is more prevalent In children with total body Involvement. Delay In cognitive/elementally development (common) Cognitive impairment is observed in 40% of patients with COP.
Intellectual disability is more common in Individuals with more severe motor Involvement (GAMES levels IV and V). Attention of primitive reflexes (common) Reflexes and reactions that are poor prognostic factors for development of Independent walking Include retention of asymmetric and symmetric tonic neck reflexes, retention of Moor (startle) reflex, retention of neck righting reflex, and presence of lower-extremity extensor thrust response. Diagnosis of COP can be made as early as 6 months of age using developmental scales, presence of sustained colons, or persistent pathological reflexes. Jack of age-appropriate reflexes (common) Lack of parachute reaction and foot placement reaction are poor prognostic factors or development of Independent walking.  Diagnosis of COP can be made as early as 6 months of age using developmental scales, presence of sustained colons, or persistent pathological reflexes. Spastic/colons (common) Spastic typically develops after the second year of life and manifests when the child attempts activities. It is confirmed by velocity-dependent resistance to passive motion, abnormally increased deep tendon reflexes, and colons.
Spastic may be accompanied by a ‘clasp knife’ phenomenon In which resistance to passive motion abruptly decreases. Elective voluntary motor control impairment (common) An inability to perform isolated motion of Joints without obligatory movement of non- toy 2 the lower extremity (SCALE). Common for spastic COP. Toe walking/knee hypertension (common) Excessive plantar flexing in patients with spastic hemophilia may manifest as unilateral toe-walking in the young child or knee hypertension in the older child or adult.
In the child with spastic depleting, bilateral toe-walking may occur. Scissoring Hip adductor or medial hamstring Spastic may manifest itself as ‘scissoring’ (crossing of the legs) during upright activities. Internal rotation of the femoral or tibiae may also mimic scissoring. Crouched gait (common) Excessive dereliction caused by weak plantar floors, hip or knee flexing conjunctures, tight hamstrings, or a combination of these factors in patients with spastic depleting contributes to a crouched gait. Intercourse (common) Progressive conjunctures or deformities occur during periods of rapid growth and can develop by 5 years of age. Fixed conjunctures are not altered by sleep or anesthesia. The severity of contractual and deformity tends to be less in patients with embalming than in those with more global involvement; hip dysphasia and deformity are rare but should not be ignored.  Patients with spastic depleting have bilateral involvement with the lower extremities being more involved than the upper extremities.